Provider Demographics
NPI:1700800174
Name:BONJRADA, JENNIFER WEINTRAUB (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:WEINTRAUB
Last Name:BONJRADA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4562
Mailing Address - Country:US
Mailing Address - Phone:434-972-1887
Mailing Address - Fax:434-220-0188
Practice Address - Street 1:401 4TH ST NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4562
Practice Address - Country:US
Practice Address - Phone:434-972-1887
Practice Address - Fax:434-220-0188
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234241041C0700X
VA09040068731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical